The perceptions and experiences of community nurses and patients towards shared decision‐making in the home setting: An integrative review

Abstract

AimTo explore patients' and community nurses' perceptions and experiences of shared decision‐making in the home.DesignIntegrative review.Data SourcesCINAHL, British Nursing Index, Psycinfo, Medline and Social Services Abstracts were searched for qualitative, quantitative and mixed methods papers published between 1 December 2001 and 31 October 2023.Review MethodsA systematic search of electronic databases was undertaken using defined inclusion criteria. The included papers were appraised for quality using the Joanna Briggs Institute critical appraisal checklist for qualitative research. Relevant data were extracted and thematically analysed.ResultsFourteen papers comprising 13 research studies were included. Patients attached great importance to their right to be involved in decision‐making and noted feeling valued as a unique individual. Communication and trust between the patient and nurse were perceived as fundamental. However, shared decision‐making does not always occur in practice. Nurses described tension in managing patients' involvement in decision‐making.ConclusionThe findings demonstrate that although patients and community nurses appreciate participating in shared decision‐making within the home, there are obstacles to achieving a collaborative process. This is especially relevant when there are fundamentally different perspectives on the decision being made. More research is needed to gain further understanding of how shared decision‐making plays out in practice and to understand the tensions that patients and nurses may experience.Implications for the Profession and/or Patient CareThis paper argues that shared decision‐making is more than the development of a relationship where the patient can express their views (though of course, this is important). Shared decision‐making requires acknowledgement that the patient has the right to full information and should be empowered to choose between options. Nurses should not assume that shared decision‐making in community nursing is easy to facilitate and should recognize the tensions that might exist when true patient choice is enabled.ImpactThis paper demonstrates how the idea of shared decision‐making needs to be explored in the light of everyday practice so that challenges and barriers can be overcome. In particular, the tensions that arise when patients and nurses do not share the same perspective. This paper speaks to the potential of a gap surrounding shared decision‐making in theory and how it plays out in practice.Reporting MethodThe reporting of this review was guided by the 2020 guidelines for the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (Page et al., 2021).Patient or Public ContributionThis review was carried out as part of a wider study for which service users have been consulted.